Ultrasonographic assessment of sugammadex-enhanced early recovery of diaphragmatic function in children

BACKGROUND: In adults, sugammadex promotes faster neuromuscular recovery compared with neostigmine; however, its impact on diaphragmatic recovery and atelectasis in children remains unelucidated. OBJECTIVES: We compared the effects of sugammadex and neostigmine on restoration of diaphragmatic function and postoperative atelectasis in paediatric patients. DESIGN: A prospective randomised controlled study. SETTING: Seoul National University Children's Hospital, Seoul, Republic of Korea. PATIENTS: A total of 73 children aged 2 to 7 years were randomised to receive either sugammadex (2 mg kg -1 , n = 36) or neostigmine (0.02 mg kg -1 , n = 37) for neuromuscular blockade reversal when the train-of-four count reached 4 (train-of-four ratio < 0.9). MAIN OUTCOME MEASURES: The diaphragmatic excursion (DE) and thickening fraction (TF) were measured by ultrasound at three timepoints: baseline (T0), before postanaesthesia care unit (PACU) admission (T1) and 30 min after PACU admission (T2). Atelectasis was assessed via lung ultrasonography at T1 and T2. The primary outcome was the diaphragmatic excursion ratio at T1 (DE T1 /DE T0 ), and secondary outcomes included the DE T2 /DE T0 , TF T1 /TF T0 , TF T2 /TF T0 atelectasis score and incidence of significant atelectasis. RESULTS: At T1, the DE T1 /DE T0 was significantly higher in the sugammadex group (neostigmine vs. sugammadex group, 0.91 ± 0.19 vs. 1.02 ± 0.24; P = 0.034) as was the TF T1 /TF T0 (0.93 ± 0.39 vs. 1.15 ± 0.49; P = 0.041). No significant intergroup differences were found in the DE T2 /DE T0 and TF T2 /TF T0 . The atelectasis score and incidence of significant atelectasis were comparable between the groups. CONCLUSIONS: Compared to neostigmine, sugammadex accelerates diaphragmatic recovery immediately after extubation; however, this early recovery does not significantly reduce the incidence of postoperative atelectasis. TRIAL REGISTRATION NUMBER: NCT05724550.